Wilson College Dual Enrollment Application

Student Information

First Name

Preferred First

Last Name

Email

Mobile Phone

I consent to receive text messages from Wilson College.

Birthdate

Legal Sex

Permanent Address

Country

Street

City

Region

Postal Code

Education

High School

Grade

Select your counselor

Semester you wish to start taking college courses:

College course/courses that are of interest to you:

Family Information

Please provide details for the parent(s)/guardian(s) with whom you live.

Parent/Guardian 1

Relationship

First Name

Last Name

Email

Phone Number

I live with an additional parent/guardian

Parent/Guardian 2

Relationship

First Name

Last Name

Email

Phone Number

Other Information

Will you need require any special accommodations while taking courses?

Please explain what assistance you will need.

Signature

I acknowledge that I must have a unweighted high school grade point average of 3.0 or higher in order to enroll in coursework at Wilson College.

I understand that a transcript of my grades for courses taken at Wilson College and/or taught by Wilson College faculty may not be released without my written consent. My signature below indicates consent to allow Wilson College to send my transcript to my high school guidance office.